Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden.
Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden; Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane University Hospital, Lund, Sweden.
J Am Soc Echocardiogr. 2018 Mar;31(3):349-360. doi: 10.1016/j.echo.2017.11.003. Epub 2017 Dec 21.
Heart function following heart transplantation (HTx) is influenced by numerous factors. It is typically evaluated using transthoracic echocardiography, but reference values are currently unavailable for this context. The primary aim of the present study was to derive echocardiographic reference values for chamber size and function, including cardiac mechanics, in clinically stable HTx patients.
The study enrolled 124 healthy HTx patients examined prospectively. Patients underwent comprehensive two-dimensional echocardiographic examinations according to contemporary guidelines. Results were compared with recognized reference values for healthy subjects.
Compared with guidelines, larger atrial dimensions were seen in HTx patients. Left ventricular (LV) diastolic volume was smaller, and LV wall thickness was increased. With respect to LV function, both ejection fraction (62 ± 7%, P < .01) and global longitudinal strain (-16.5 ± 3.3%, P < .0001) were lower. All measures of right ventricular (RV) size were greater than reference values (P < .0001), and all measures of RV function were reduced (tricuspid annular plane systolic excursion 15 ± 4 mm [P < .0001], RV systolic tissue Doppler velocity 10 ± 6 cm/sec [P < .0001], fractional area change 40 ± 8% [P < .0001], and RV free wall strain -16.9 ± 4.2% [P < .0001]). Ejection fraction and LV global longitudinal strain were significantly lower in patients with previous rejection.
The findings of this study indicate that the distribution of routinely used echocardiographic measures differs between stable HTx patients and healthy subjects. In particular, markedly larger RV and atrial volumes and mild reductions in both LV and RV longitudinal strain were evident. The observed differences could be clinically relevant in the assessment of HTx patients, and specific reference values should be applied in this context.
心脏移植（HTx）后的心脏功能受众多因素影响。通常使用经胸超声心动图进行评估，但目前针对这种情况尚无参考值。本研究的主要目的是为临床稳定的 HTx 患者推导腔室大小和功能（包括心脏力学）的超声心动图参考值。
该研究前瞻性纳入了 124 例健康的 HTx 患者。患者根据当代指南接受了全面的二维超声心动图检查。将结果与健康受试者的公认参考值进行比较。
与指南相比，HTx 患者的心房尺寸更大。左心室（LV）舒张末期容积更小，LV 壁厚度增加。就 LV 功能而言，射血分数（62±7%，P<0.01）和整体纵向应变（-16.5±3.3%，P<0.0001）均降低。所有 RV 大小测量值均大于参考值（P<0.0001），所有 RV 功能测量值均降低（三尖瓣环平面收缩期位移 15±4mm [P<0.0001]、RV 收缩组织多普勒速度 10±6cm/sec [P<0.0001]、节段性面积变化 40±8% [P<0.0001]和 RV 游离壁应变-16.9±4.2% [P<0.0001]）。有既往排斥反应的患者的射血分数和 LV 整体纵向应变明显较低。
本研究的结果表明，稳定的 HTx 患者与健康受试者之间常规使用的超声心动图测量值的分布存在差异。特别是明显更大的 RV 和心房容积以及 LV 和 RV 纵向应变的轻度降低。观察到的差异在 HTx 患者的评估中可能具有临床意义，并且在这种情况下应应用特定的参考值。
